Does Medicaid Spur Opioid Abuse?

Overdoses and hospital visits have grown far more in states that took the ObamaCare expansion

By Allysia Finley of The WSJ. Excerpts:

"government health-care programs are among the biggest suppliers of prescription painkillers."

"overdose deaths per capita rose twice as much on average between 2013 and 2015 in states that expanded Medicaid than those that didn’t—for example, 205% in North Dakota, which expanded Medicaid, vs. 18% in South Dakota, which didn’t."

"the number of opioid-related inpatient hospital stays nationwide (among states submitting data) that were paid for by Medicaid increased by about 40% between the fourth quarters of 2012 and 2014—about four times the rate of growth in Medicaid enrollment. Patient stays covered by private insurance increased 4% during this period.

Hospital and emergency-room admissions after 2013 likewise increased more in expansion states than in nonexpansion states with similar demographics and geography. It’s true that opioid-related visits by the uninsured dropped in many expansion states. But that can’t entirely account for the increase in Medicaid-paid hospitalizations. Between 2012 and 2014, emergency-room visits by Medicaid patients in Ohio doubled; enrollment increased 10%. But visits by the uninsured and Medicaid beneficiaries combined increased 40% during this period, which suggests an overall increase of use among low-income populations.

So what could help explain the apparent association between Medicaid and opioid abuse? For one, Medicaid patients may be more likely to be prescribed opioids—twice as likely, according to two studies, as privately insured individuals. A recent study by Express Scripts Holding found that about a quarter of Medicaid patients were prescribed an opioid in 2015.

State Medicaid programs also favor generics over more expensive branded painkillers with abuse-deterrent formulas. According to the Express Scripts study, generics accounted for 90% of Medicaid opioid medication claims. Large doses of oxycodone, methadone and fentanyl can be obtained cheaply with a Medicaid card and resold for a nice profit on the black market."